Parent-Child Interaction Therapy (PCIT) for Children Ages 2-7 with Disruptive Behavior

Parent-Child Interaction Therapy (PCIT) is an evidence-based treatment for children ages 2-7 with behavior problems such as aggression, impulsivity, and defiance. The most common presenting problems in families include: not following caregivers’ directives, frequent tantrums, hitting/hurting, whining and other annoying behaviors, and things like running away in public. Typical diagnoses are ADHD or ODD, although there does not have to be a diagnosis at all; treatment also works well for children with autism.

The way that PCIT works is really unique: The therapist does not directly interact with the child for most of the treatment. During therapy, parents play toys with their child while they are coached in the ear in what to do and say, using a specific skill set they have learned. In this way, the caregiver, rather than the therapist, is the agent of change. Parents learn how to reward their child for appropriate behavior and provide an appropriate consequence for challenging behaviors. Therapy continues until the parent can effectively manage the various behaviors of their child and they feel confident in their new skill set.

PCIT is based on two approaches. First, behaviorism teaches how to reinforce a desired behavior and decrease an unhelpful behavior. Second, attachment theory informs strengthening the bond with your child. PCIT has two phases, Child Directed Interaction (CDI) and Parent Directed Interaction (PDI) based on these principles.

PCIT has 40+ years of research backing. (You can find more information for parents here and the research here.) PCIT can only be delivered by therapists who are certified, which is a process of training and completing supervised therapy hours in the treatment. My first experience with PCIT was as a research assistant in college and I became certified during my predoctoral internship.

I conduct PCIT virtually, which has actually shown to be potentially more effective than in-person PCIT. I believe this is ideal because therapy is happening in the same location where daily practice will occur.

Caregivers who attend appointments every week and engage in daily practice are generally ready to graduate therapy, within about 3-4 months of treatment (although this cannot be guaranteed). The biggest factor in the child finding success is having a caregiver who is consistently attending therapy, practicing the skills, and just generally thinking of PCIT as a new language and way of behaving with their child. These families usually see results way faster than they expected!

I do not expect a family to have this sort of hopefulness from the beginning of therapy. How could you when you feel like you’re in the middle of a tornado? But with therapist guidance, change is possible. Most importantly, PCIT is attachment-based and parents can get back to what everyone wants happening: bonding and enjoying time with their child.